INS application for advance parole travel document by Epstein associate, 1995

EFTA01263142¶

U.S. Department of Justice¶

Immigration and Naturalization Service¶

OMB #1115-0005¶

Application for Travel Document¶

START HERE - Please Type or Print¶

Part 1. Information about you.¶

Family Name Maxwell	Given Name Ghislaine		Middle Initial N
Address C/O
Street Number and Name			Apt. # 8A
City New York		State or Province NY
Country USA		ZIP/Postal Code 10021
Date of Birth(Month/Day/Year)		Country of Birth France
Social Security #		A#

Part 2. Application Type (check one).¶

a. □ I am a permanent resident or conditional resident of the United States and I am applying for a Reentry Permit.¶

b. □ I now hold U.S. refugee or asylee status and I am applying for a Refugee Travel Document.¶

c. □ I am a permanent resident as a direct result of refugee or asylee status, and am applying for a Refugee Travel Document.¶

d. ☑ I am applying for an Advance Parole to allow me to return to the U.S. after temporary foreign travel.¶

e. □ I am outside the U.S. and am applying for an Advance Parole.¶

f. □ I am applying for an Advance Parole for another person who is outside the U.S. Give the following information about that person:¶

Family Name	Given Name	Middle Initial
Date of Birth (Month/Day/Year)	Country of Birth

Foreign Address - C/O¶

Street Number and Name	Apt. #
City	State or Province
Country	ZIP/Postal Code

Part 3. Processing Information.¶

Date of Intended departure(Month/Day/Year)10/17/95		Expected length of trip1 week to 10 days
Are you, or any person included in this application, now in exclusion or deportation proceedings?☐No ☐Yes, at(give office name)
If applying for an Advance Parole Document,skip to Part7.
Have you ever before been issued a Reentry Permit or Refugee Travel Document?☐No ☐Yes(give the following for the last document issued to you)N/A Date Issued Disposition(attached, lost, etc.)

Form I-131 (Rev. 12/10/91) N¶

Continued on back.¶

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08.11 \¶

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370.00¶

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FOR INS USE ONLY¶

Returned	Receipt
___	___
Resubmitted	___
___	___
Reloc Sent	RECEIVED 3rd FLOOR CASHIER OCT 17 1995 Immigration and Naturalization Service New York, N.Y.
___	___
Reloc Rec’d	___
___	___
□ Applicant Interviewed on

Document Issued¶

• □ Reentry Permit
• □ Refugee Travel Document
• □ Single Advance Parole
• □ Multiple Advance Parole Validity to OCT 17, 1996

If Reentry Permit or Refugee Travel Document¶

• □ Mail to Address in Part 2
• □ Mail to American Consulate
• □ Mail to INS overseas office AT

Remarks:¶

• □ Document Hand Delivered On By

Action Block¶

To Be Completed by Attorney or Representative, if any¶

• □ Fill in box if G-28 is attached to represent the applicant

VOLAG#¶

ATTY State ID: M_00000737¶

APPROVED¶

OCT 17 1995¶

NYC | 5329¶

EFTA_00114821¶

EFTA01263143¶

Part 3. Processing Information. (continued)¶

Where do you want this travel document sent? (check one) N/A¶

a. □ Address in Part 2, above b. □ American Consulate at (give City and Country, below) c. □ INS overseas office at (give City and Country, below) City Country¶

If you checked b. or c., above, give your overseas address:¶

Part 4. Information about the Proposed Travel. N/A¶

Purpose of trip. If you need more room, continue on a separate sheet of paper.	List the countries you intend to visit.

Part 5. Complete only if applying for a Reentry Permit. N/A¶

• less than 6 months [ ] 2 to 3 years
• 6 months to 1 year [ ] 3 to 4 years
• 1 to 2 years [ ] more than 4 years

Since becoming a Permanent Resident (or during the past five years, whichever is less) how much total time have you spent outside the United States?¶

Since you became a Permanent Resident, have you ever filed a federal income tax return as a nonresident, or failed to file a federal return because you considered yourself to be a nonresident? (if yes, give details on a separate sheet of paper).¶

[ ] Yes [ ] No¶

Part 6. Complete only if applying for a Refugee Travel Document. N/A¶

Country from which you are a refugee or asylee:
If you answer yes to any of the following questions, explain on a separate sheet of paper.
Do you plan to travel to the above-named country?	Yes	No
Since you were accorded Refugee/Asylee status, have you ever: returned to the above-named country; applied for an/or obtained a national passport, passport renewal, or entry permit into this country; or applied for an/or received any benefit from such country(for example, health insurance benefits)?	Yes	No
Since being accorded Refugee/Asylee status, have you, by any legal procedure or voluntary act, re-acquired the nationality of the above-named country, acquired a new nationality, or been granted refugee or asylee status in any other country?	Yes	No

Part 7. Complete only if applying for an Advance Parole.¶

On a separate sheet of paper, please explain how you qualify for an Advance Parole and what circumstances warrant issuance of Advance Parole. Include copies of any documents you wish considered. (See instructions.)¶

For how may trips do you intend to use this document? ☐ 1 trip More than 1 trip¶

If outside the U.S., at right give the U.S. Consulate or INS office you wish notified if this application is approved.¶

For how may trips do you intend to use this document? ☐ 1 trip ☑ More than 1 trip¶

If outside the U.S., at right give the U.S. Consulate or INS office you wish notified if this application is approved.¶

Part 8. Signature.¶

Read the information on penalties in the instructions before completing this section. You must file this application while in the United States if filing for a reentry permit or refugee travel document.¶

I certify under penalty of perjury under the laws of the United States of America that this petition, and the evidence submitted with it, is all true and correct. I authorize the release of any information from my records which the Immigration and Naturalization Service needs to determine eligibility for the benefit. I am seeking.¶

Signature¶

Date 10/16/95¶

Daytime Telephone # (212) 750-9895¶

Please Note: If you do not completely fill out this form, or fail to submit required documents listed in the instructions, you may not be found eligible for the requested document and this application will have to be denied.¶

Part 9. Signature of person preparing form if other than above. (sign below)¶

Signature	Print Your Name	Date
Firm Nameand Address		Daytime Telephone#( )

EFTA_00114822¶

EFTA01263144¶